Wednesday, May 24, 2006

Med Page Today Action Points:* Note that this research suggests that poor health in soldiers without an obvious cause is strongly associated with post-traumatic stress disorder.* These studies were published as abstracts and presented orally at a conference. These data and conclusions should be considered to be preliminary as they have not yet been reviewed and published in a peer-reviewed publication.REVIEWTORONTO, MAY 23---Combat troops meeting the criteria for post-traumatic stress disorder (PTSD) who are still on active duty are much more likely to have physical health problems than their comrades, according to research presented here.Most earlier studies of PTSD have focused on veterans many years after they have returned from combat and found strong association between the disorder and poor health, said Artin Terhakopian, M.D., of the Walter Reed Army Medical Center in Silver Spring, Md., at the American Psychiatric Association meeting here. The new research is on active duty personnel---"working soldiers"---he added.The researchers studied 2,863 soldiers of the U.S. Army combat brigades that had been rotated back to the U.S. after duty in Iraq, Dr. Terhakopian and colleagues found dramatic differences between the 16% who were diagnosed as suffering from PTSD and those who were not.Using an anonymous survey a year after the soldiers' return from combat duty in Iraq, Dr. Terhakopian and colleagues examined PTSD symptoms, self-rated health, sick call visits, and missed work days, as well as physical symptoms evaluated on a 15-point Patient Health Questionnaire (PHQ-15).THE STUDY FOUND:* 468 of the 2,815 soldiers who returned the surveys---or 16.6%---were suffering from PTSD.* Of those, 46.7% reported their health as fair or poor, compared with 19.8% of those without PTSD. The odds ratio was 3.56 and was statistically significant at P<0.0001.* 37.6% of those with PTSD had two or more recent sick call visits, compared with 20.5% of those without PTSD. The odds ratio was 2.33 and was significant at P<0.0001.* 11.8% of those with PTSD reported recently missing two or more days of work because of illness, compared with 6.5%. The odds ratio was 1.93, and was significant at P<0.0001.* Finally, 34.4% of those with PTSD had a PHQ-15 score indicating ill health, compared to 5.2% of their comrades. The odds rate was 9.64 and was significant at P<0.0001.Dr. Terhakopian noted that the study was cross-sectional, so that no conclusion can be drawn about whether PTSD causes ill health or vice versa. But he added that the clinical implication is that veterans with ill health without other obvious causes should be suspected of suffering from PTSD and offered treatment.The Walter Reed researchers did not report the effect of injury on PTSD, but scientists from the Naval Medical Center at San Diego showed that battlefield injuries are more highly linked to PTSD than the usual run of medical conditions that can cause soldiers to be evacuated from a war zone.In a retrospective chart review, David Oliver, M.D., and the colleagues at the center, analyzed the relationship of PTSD with both branches of service and reason for being evacuated from the war zone. Since 2004, the San Diego center has been the receiving station for military personnel medevaced from Iraq, he said.The majority of the personnel with PTSD or acute stress syndrome were marines, Dr. Oliver said, and most of the remainder were sailors. However, there was no statistically significant link between branch of service and the chance of having PTSD, he said.On the other hand, the researchers found, there was a significant link to the reason for evacuation. Those who came home because of a battlefield injury or for psychiatric reasons were significantly more likely to suffer from PTSD, compared to those with non-battlefield injuries or other medical circumstances.Specifically, 26% of those with battlefield injuries and 48% of those with psychiatric issues had PTSD, compared with 17% of those with non-battlefield injuries or other medical concerns. A chi-square analysis showed that the differences were statistically significant at P<0.05.Source:MedPage TodayBy: Michael Smith, MedPage Today Staff WriterReviewed By: Ruben K. Israni, M.D.Pennsylvania School of MdicineMay 23, 2006